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Menopausal women will make up the biggest U.S. demographic — so why is medicine still ignoring them?


Even though women represent half the population, the natural transition of menopause has been a taboo subject for generations. In the past, scurvy, epilepsy, schizophrenia, madness, hysteria were all blamed on menopause.

As recently as the 1960s, menopausal women were called “crippled castrates.”

Lisa Mosconi, a neuroscientist and women’s health advocate, aims to change that.

Menopause is not something that happens to an individual. It is a physical change that is experienced by half of the population, as well as a societal issue. A recent Mayo Clinic study estimated that menopause-related symptoms cost the U.S. $1.8 billion annually in lost work time and $26.6 billion each year, including medical expenses. By 2030, 47 million women worldwide will enter menopause each year.

There have been more open conversations about menopause recently. Public figures such as Michelle Obama and Maria Shriver and celebrities including Oprah Winfrey, Gwyneth Paltrow, Drew Barrymore and Naomi Watts have been raising the topic, while some companies have been adding menopause-specific benefits to their corporate offerings.

Even with some raised awareness, the experience of menopause is often ignored or presented as a punch line.

With her new book, “The Menopause Brain,” Mosconi wants to open the conversation about women’s health, advocate for better and more equitable care for women, and explain the complexities of menopause on the body and the brain. The new book builds on the work of her previous books, “XX Brain” and “Brain Food.” Mosconi is an associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine and the director of the Alzheimer’s Prevention Program at WCM/NewYork-Presbyterian Hospital.

MarketWatch: Does menopause need rebranding?

Mosconi: I would say so. I really feel as a woman and a scientist that menopause has been treated really poorly in society, especially in Western medicine and the Western world, where all the attention has been on the potential pitfalls. The dignity of this important life transition has been taken away and there’s this parade of symptoms and risk and treatments and despair and making women invisible. Basically, menopausal women have been made invisible by society and dramatically overlooked by medicine — and this is unacceptable. Just think about the sheer numbers: by 2030 there will be 1 billion women just entering or about to enter menopause — women of menopausal age are the fastest-growing demographic group and women spend 40% of their life in menopause. 

Menopause really needs a rebranding, from something women are scared of and women dread, to being just another phase of life women will go through if they live long enough. It comes with some symptoms and some vulnerabilities, but it also brings another dimension to a woman’s life that we’re just starting to understand. There’s a good that comes out of menopause that Western medicine has just completely decided to ignore.

MarketWatch: You mention in the book that menopausal women are underserved and represent a great blind spot in medicine? Do you see that changing or improving?

Mosconi: There has been a change, but it has been very marginal. In part because of the funding. If you look at the federal budget for healthcare, the NIH budget, there’s a certain amount of money directed towards women’s health. The vast majority of it is directed to breast cancer, cardiovascular disease, osteoporosis and the subcategory of aging is at the bottom of the list. Menopause is a subcategory of the subcategory. It’s like three, four grand (of funding). It’s nothing. There’s hope that priorities will shift with the new women’s health initiative that the White House announced a few months ago. We’ll see.  

Credit: Courtesy of Penguin Random House

MarketWatch: Some companies are adding menopause-support benefits for their employees. Is this the start of a mindset change or just a trendy thing to do?

Mosconi: It might be a combination of both. With pregnancy, the United States does not have that much support in place for pregnancy and the postpartum time — if you’re lucky, you get three months with a newborn. There’s an understanding that a woman needs a little bit of a break after she has a child and that’s something finite — months. 

The problem with menopause is that it’s a longer process that can span years. Some women can transition in two years, but others can take up to 14 years — that’s obviously an extreme. But the average in the United States is seven years. That’s seven years in which a woman may legitimately have a hard time. It’s just humane to provide some extra flexibility and benefits during that time. I think in part it is a little bit trendy, but more and more women are realizing it’s something to fight for.

MarketWatch: In your book, you mention that menopause can be reflected as several hundred unique symptom combinations. That sounds like an insurmountable issue to diagnose and treat and endure. Can you talk about that?

Mosconi: The diagnosis of menopause is relatively simple. You go to your ob-gyn and hope they’ve been trained in menopausal care, which is 1 in 5. All that happens is that you’re asked, “Do you have a menstrual cycle?” The diagnosis is done retroactively. You have to have gone a full year without any menstrual cycle. That process is straightforward. But we’re trying to bring in the brain component. That diagnosis is based on the ovaries. The symptoms that women experience — at least half — have nothing to do with your ovaries but everything to do with your brain. We need to bring more fields together and refine the diagnosis of clusters of symptoms, but we’re not there yet.

MarketWatch: What are some of the upsides of menopause?

Mosconi: In Japan, they don’t have a word for menopause like we do here. Here, it’s the end of your menstrual cycle. In Japan, they have a beautiful word “konenki,” which is renewal, a regeneration, a next stage of life. It doesn’t put a strong weight towards the negative. It’s a new phase of a woman’s life. That takes a lot of the stress and stigma away. 

Happiness is one of the most surprising things I’ve learned about menopause. Post-menopausal women are generally happier than younger, pre-menopausal women. And they are generally happier than they themselves were before going through menopause. There are many cultural studies that look at better mental health and greater life contentment after menopause. 

Then there’s emotional mastery, which so many women report: I don’t quite care as much as I used to about things that no longer serve me. I’m no longer upset about certain things. I no longer let people tell me what to do. There’s more self-confidence and determination and more sense of a person’s sense of worth that comes with the ability to sustain joy. Studies show there is a neurological reason for this. The part of the brain that is involved in emotional control gets rewired in such a way that they don’t overreact to negative situations but still maintain a good response to positive situations. You don’t sweat the small stuff. Post-menopausal women tend to be extremely good at empathy. There are certainly pluses we’re just starting to study.

MarketWatch: Do you see the need for federally funded or more comprehensive research on the impact of menopause on the body and the brain? Or women’s health in general?

Mosconi: I think sex and gender differences in brain health is a major priority. Women’s brain health, in particular, one of the most under-researched, under-diagnosed, under-treated, under-funded fields of medicine and that includes menopause. Neuroscience was really based on this concept that reproduction has no impact on brain health — which turns out to be completely incorrect. That would be my number one priority — how brain health plays out differently. We’re missing out on a lot of important information. Take pharmacology, we’ve known for a really long time that women do not metabolize drugs the same way men do. We don’t even metabolize food the same way. The vast majority of drugs that we have that were developed in the past 20 years were tested exclusively on men and that’s why many drugs don’t work as well on women. Women’s brains have been really, really overlooked.

MarketWatch: Beyond medicine, what lifestyle issues should women take on during and after menopause?

Mosconi: There are things found to be associated with an easier menopause and they are chiefly exercise of any sort. But it depends a little bit on the symptoms. If you have hot flashes and brain fog, cardiovascular exercise seems to be most helpful. If you’re having mood changes and depression, then a combination of cardio and strength training seems to be quite effective. If someone has issues with stress and sleep, then exercise like pilates and yoga and mind-body techniques can help. There isn’t a lot of research on this still. But there is some indication of what would be most helpful. 

A Mediterranean-style diet seems to be very helpful for women’s health. Women who follow this kind of diet have about 20% fewer hot flashes and lower risk of chronic diseases like cardiovascular disease, stroke, diabetes, hypertension and dementia. Stress reduction is important. Sleep hygiene is really important and avoiding toxins — it’s become increasingly recognized that there are toxins in the environment that can negatively affect hormonal health and that’s leading to precocious puberty in girls, an increase in endometriosis, and also early onset menopause, and a risk factor for dementia, as well, since toxins can really impact your brain.  

MarketWatch: As a neuroscientist and women’s health specialist, how are you preparing for menopause?

Mosconi: I’m working on my lifestyle. I want a really strong baseline when I get there. I’m working on my sleep hygiene. A consistent routine. No sound. No light. No screens in my bedroom. I’m doing meditation more consistently than ever before. It just takes 10 to 12 minutes and I feel better than ever before. I’m exercising more — five times a week. Doing more cardio, Pilates, and my diet is super clean — I eat no processed foods at all. No sugar in the house. I’ve green-ified my diet. I follow a Mediterranean diet but I try to increase the green in my diet — more fruits and veggies. No alcohol and I just switched to decaf. I think this is the core to avoid all the things that could make menopause worse and try to focus on all the things that are known to make it better and pray and hope for the best.

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